Individual
LESLIE JARROTT MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1333 TAYLOR ST STE 5F, COLUMBIA, SC 29201-2951
(803) 748-9966
(803) 748-7174
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
32261
SC
208C00000X
Colon & Rectal Surgery Physician
Primary
32261
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
322617
—
SC
01
—
P00944488
MEDICARE RAILROAD
SC
Enumeration date
04/14/2006
Last updated
09/26/2018
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